AIHW - Patients Spending on Medicare - Out-of-pocket Cost per Specialist and Obstetric Attendance (PHN) 2016-2017

This dataset presents the footprint of the percentage of patients with specialist and obstetric costs, and out-of-pocket cost per specialist and obstetric attendance at the 25th, 50th, 75th and 90th percentile. The data spans the financial year of 2016-2017 and is aggregated to 2015 Department of Health Primary Health Network (PHN) areas, based on the 2011 Australian Statistical Geography Standard (ASGS).\n\nThe data is sourced from the Medicare Benefits Schedule (MBS) claims data, which are administered by the Australian Government Department of Health. The claims data are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim has been processed by the Department of Human Services. Data are reported for claims processed between 1 July 2016 and 30 June 2017. The data also contains the results from the ABS 2016-17 Patient Experience Survey, collected between 1 July 2016 and 30 June 2017. The Patient Experience Survey is conducted annually by the Australian Bureau of Statistics (ABS) and collects information from a representative sample of the Australian population. The Patient Experience Survey is one of several components of the Multipurpose Household Survey, as a supplement to the monthly Labour Force Survey.\n\nThe Patients' spending on Medicare Services data accompanies the [Patients' out-of-pocket spending on Medicare services 2016-17 Report](https://www.aihw.gov.au/reports/health-welfare-expenditure/patient-out-pocket-spending-medicare-2016-17/contents/summary).\n\nFor further information about this dataset, visit the data source:[Australian Institute of Health and Welfare - Patients' out-of-pocket spending on Medicare services Data Tables.](https://www.aihw.gov.au/reports/health-welfare-expenditure/patient-out-pocket-spending-medicare-2016-17/data)\n\nPlease note:\n\n * AURIN has spatially enabled the original data using the [Department of Health - PHN Areas.](https://www1.health.gov.au/internet/main/publishing.nsf/Content/PHN-Home)\n\n * Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes.\n\n * Obstetric attendances are Medicare-subsidised antenatal visits and attendances for the planning and management of pregnancy, as well as obstetric procedures involving non-admitted patients. These services can be provided by an obstetrician or GP. Selected services can also be provided by a midwife, nurse or Aboriginal and Torres Strait Islander health practitioner when the service is provided on behalf of, and under the supervision of, a medical practitioner.\n\n * Out-of-pocket cost per service is the net cost to the patient of a health service, after deducting the Medicare benefit paid. The measure is calculated per patient (patients' annual out-of-pocket cost for eligible attendances, divided by the number of eligible attendances that the patient claimed in the year), for patients with out-of-pocket costs.\n\n * The data is based on the patient's Medicare enrolment postcode, not where they received the health care service. Most peoples' Medicare enrolment postcode will be their residential postcode.\n\n * If a service was flagged as bulk-billed, then the fee charged was set to equal the benefit paid (so there was no out-of-pocket cost for that service).\n\n * Patients were excluded if the sum of eligible services in the year was less than one, or if their annual out-of-pocket expenditure on the eligible services was equal to or less than zero.\n\n * Includes non-hospital Medicare-subsidised services only.\n\n * NP - Not available for publication. The estimate is considered to be unreliable. Values assigned to NP in the original data have been set to null.\n

本数据集呈现了专科诊疗与产科诊疗相关患者占比，以及各专科、产科单次就诊的自费费用在25分位、50分位、75分位和90分位的分布情况。数据覆盖2016-2017财年，以2011年澳大利亚统计地理标准（Australian Statistical Geography Standard, ASGS）为基准，聚合至2015年澳大利亚卫生署基层卫生网络（Primary Health Network, PHN）辖区。

本数据集的数据来源为澳大利亚卫生署管理的医疗保险福利计划（Medicare Benefits Schedule, MBS）理赔数据。该理赔数据源自符合1973年《健康保险法》规定、可申领澳大利亚医疗保险福利的医疗服务行政记录，且已由澳大利亚人类服务部完成理赔审核。本次公开的数据对应2016年7月1日至2017年6月30日期间完成审核的理赔申请。此外，数据集还包含2016-17年度患者体验调查的结果，该调查于2016年7月1日至2017年6月30日期间开展，由澳大利亚统计局（Australian Bureau of Statistics, ABS）每年面向澳大利亚代表性人口样本实施，旨在收集民众医疗体验相关信息。患者体验调查作为多用途家庭调查的组成部分之一，同时也是月度劳动力调查的补充模块。

本《澳大利亚医疗保险服务患者自费支出数据集》配套发布于《2016-17年度澳大利亚医疗保险服务患者自费支出报告》（https://www.aihw.gov.au/reports/health-welfare-expenditure/patient-out-pocket-spending-medicare-2016-17/contents/summary）。

如需获取本数据集的更多详情，请访问数据源页面：澳大利亚卫生与福利研究所（Australian Institute of Health and Welfare, AIHW）《澳大利亚医疗保险服务患者自费支出数据集》（https://www.aihw.gov.au/reports/health-welfare-expenditure/patient-out-pocket-spending-medicare-2016-17/data）。

请注意：
* AURIN已基于澳大利亚卫生署基层卫生网络辖区，对原始数据完成空间化处理，相关地理边界详情可访问：https://www1.health.gov.au/internet/main/publishing.nsf/Content/PHN-Home。
* 专科就诊：指符合澳大利亚医疗保险福利申领资格的转诊患者与专科医师的诊疗互动，包括面诊、线下咨询及远程视频会诊，参与医师需为澳大利亚医疗保险体系认定的专科医师或会诊医师。
* 产科就诊：指符合澳大利亚医疗保险福利申领资格的产前检查、妊娠规划与管理相关就诊，以及非住院患者的产科诊疗服务。此类服务可由产科医师或全科医师提供，经医师委派并监督的情况下，助产士、护士或原住民与托雷斯海峡群岛医疗从业者也可提供部分指定服务。
* 单次服务自费费用：指患者在扣除医疗保险已报销金额后，需自行承担的医疗服务净成本。该指标针对存在自费支出的患者，以单患者为统计单位，计算公式为：患者年度内符合资格的就诊项目自费总支出 ÷ 该患者年度内申报的符合资格就诊项目总次数。
* 本数据集基于患者的医疗保险登记邮编进行聚合，而非患者接受医疗服务的实际地点。绝大多数患者的医疗保险登记邮编与其常住地址邮编一致。
* 若某项医疗服务标记为"全额报账（bulk-billed）"，则服务收费金额等于医疗保险报销金额，即患者无需承担该服务的自费成本。
* 若患者年度内符合资格的医疗服务总次数少于1次，或其年度内符合资格服务的自费支出总额小于等于0，则该患者的相关数据将被排除。
* 本数据集仅包含非住院类的澳大利亚医疗保险补贴医疗服务。
* NP：代表不可公开发布，相关统计估计值被认定为不可靠。原始数据中标记为NP的数值已统一设置为空值。